Cognitive Rehabilitation Techniques

Cognitive rehabilitation techniques are often geared to three broad categories: restore, substitute, or restructure. Techniques for restoring cognitive functions include cognitive training and exercises directed toward strengthening and the reestablishment of impaired abilities. Substitute techniques commonly include external prosthetic devices and compensatory strategies utilized in place of impairments, which do not attempt to ameliorate impairments. Lastly, restructure techniques reorganize the client's environment in order to compensate for impairments. The following are examples of the most common cognitive rehabilitation techniques and approaches:

• Computer training utilizes multipurpose software for assessment, treatment planning, treatment, data analysis, progress recording, and reporting. Multimedia applications are also used for education and simulation.

• Memory retraining often involves teaching a client to use rehearsal techniques to maintain information within memory.

• Social skills training primarily involves training conversation tracking skills, eye contact, initiation, attention, and appropriate behavioral skills.

• Use of prosthetic devices involves using external aids rather than retraining the cognitive deficit (e.g., memory watch, calculator, tape recorder, pill organizer, and voice recognition software).

• Stimulation therapy is the oldest type of cognitive rehabilitation. It involves direct retraining through paper-and-pencil exercises and computer programs that require one or more mental skills.

• Process training is similar to stimulation therapy but is designed to improve only one specific aspect of cognition.

• Attention and concentration training is designed to improve one's ability to focus attention, maintain vigilance, resist distraction, and perform mental manipulations quickly and efficiently.

• Stimulus-response conditioning involves the identification of rewards and punishments and then either providing or withholding these in order to affect some desired change.

• Strategy training involves the teaching of mental sets that are applicable in other situations (e.g., mnemonics, conversation skills, and problem-solving skills).

• Domain-specific training provides guidance with the use of simulated life experiences or within a specific functional domain (e.g., computer-simulated driving).

• The cognitive cycle technique is a five-step process for retraining complex executive functioning skills. The five steps include having the client identify goals, determine methods of achieving the goals, act to achieve goals based on chosen method, assess progress, and, if necessary, repeat the process until the desired goal is achieved.

• Enhancement of physical and emotional health and social functioning is an indirect approach that focuses on changes to one's overall lifestyle (e.g., stress reduction, better nutrition, exercising regularly, and getting enough sleep and relaxation).

• Nutrient and drug treatment is a relatively new approach involving the use of various drugs and nutrients believed to improve brain functioning to treat cognitive deficits (e.g., nootropics, vasodilators, mechanism-based drugs, nutrients, herbs, minerals, antioxidants, and vitamins).

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